Endo E1 Flashcards
(154 cards)
1
Q
Which of the following hormones uses cholesterol as a substrate for synthesis? A. Dopamine B. Estrogen C. Somatostatin D. Thyroid stimulating hormone
A
B
2
Q
Which of the following is true regarding peptide hormones?
A. Diffuses through the cell membrane to bind with nuclear receptors
B. Interact with cell surfaces membrane receptors
C. Lipid soluble
D. Rate of secretion aligned with rate of synthesis
A
B (A, C, and D pertain to steroid hormones)
3
Q
Which of the following is TRUE regarding hormone synthesis and secretion?
A. Many peptide hormones are embedded within a larger precursor polypeptide that are proteolytically processed to yield the biologically active hormone
B. Synthesis of most steroid hormones is based on modifications of tyrosine
C. Peptide hormones are secreted in the circulation just after they are synthesized
D. In most instances, the stimulus for peptide hormone secretion is a releasing factor or neural signal that induces rapid changes in intracellular sodium concentrations
A
A (B pertains to thyroid hormone, C is false because they are usually stored in secretory vesicles first, D is false because it should calcium concentrations)
4
Q
Which of the following pair is correctly matched A. Activin – G-protein coupled receptor B. Insulin – Receptor tyrosine kinase C. Prolactin – Serine kinase D. TSH – Cytokine receptor linked kinase
A
B (A dapat with TGF-receptor, C is with cytokine receptor, D is with G-protein coupled receptor)
5
Q
Which of the following is true regarding the principle of hormonal regulation?
A. Hypothalamus produces releasing hormones to stimulate target organs directly
B. Paracrine regulation states that factors released by one cell acts on the same cell that produced it
C. Somatostatin secreted by pancreatic islet delta cells inhibiting insulin secretion by beta cells is an example of an autocrine regulation
D. Target organs produces hormones which feedbacks to inhibit release of hormones at the pituitary and hypothalamus
A
D
A is false because the hypothalamus secretes hormones that act on the pituitary, not the target organs directly. B is the definition of autocrine regulation, while C is an example of paracrine regulation
6
Q
Which is an example of an autocrine regulation?
A. Estrogen promoting closure of the epiphysis
B. Cortisol promoting hyperglycemia
C. IGF-1 acts on the chondrocyte that produces it
D. Somatostatin inhibiting insulin secretion from the beta cells
A
C
7
Q
True of pituitary adenomas
A. May cause either hyperpituitarism or hypopituitarism
B. Microadenomas are more common in young patients
C. Most commonly corticotrophs
D. Most often plurihormonal
A
A (C is false because most commonly non-functioning)
8
Q
Basic histologic morphology of pituitary adenoma A. Uniform appearance of cells B. Absence of reticulin network C. Eosinophilic cytoplasm D. Only A and B
A
D
9
Q
The most common cause of hyperpituitarism A. Craniopharyngioma B. Hypothalamic adenoma C. Pituitary adenoma D. Pituitary hyperplasia
A
C (most commonly a prolactin-secreting adenoma)
10
Q
Hypopituitarism due to ischemic necrosis of the gland, usually due to postpartum hemorrhage A. Pituitary apoplexy B. Empty sella syndrome C. Nelson’s syndrome D. Sheehan’s syndrome
A
D
11
Q
This type of adenoma is quite difficult to recognize because it secretes hormone variably and inefficiently and is paradoxically associated with hypofunction A. Corticotroph adenoma B. Gonadotroph adenoma C. Somatotroph adenoma D. Thyrotroph adenoma
A
B
12
Q
True of non-functioning adenomas
A. Approximately 40% of adenomas are non-functioning
B. Immunohistochemistry studies most often demonstrate diffuse acidophilia
C. Symptoms are related to mass effects
D. AOTA
A
C
13
Q
A significant condition related to disorders of the posterior pituitary A. Central diabetes insipidus B. Gestational diabetes C. Impaired glucose tolerance D. Nephrogenic diabetes insipidus
A
A
14
Q
True of the neurohypophysis
A. Hormones of neurohypophysis are produced in the anterior pituitary
B. Microscopically, it is composed of modified glial cells and axonal processes
C. Releases stimulating hormones
D. AOTA
A
B
15
Q
True of posterior pituitary hormones
A. Antidiuretic hormone also acts as a vasodilator and platelet aggregation inhibitor
B. Oxytocin relaxes uterine smooth muscles
C. Vasopressin conserves water by restricting diuresis during periods of dehydration and hypovolemia
D. AOTA
A
C
16
Q
A 30/F consults due to secondary amenorrhea. Which of the following problems best localizes the problem to the pituitary gland? A. Bitemporal hemianopsia B. Galactorrhea C. Headache D. Secondary amenorrhea
A
A
17
Q
What level or value of prolactin is invariably indicative of a prolactin-secreting pituitary adenoma? A. 25 ug/L B. 100 ug/L C. 200 ug/L D. 30 ug/L
A
C
18
Q
Which of the following drugs can increase prolactin levels? A. Calcium channel blocker verapamil B. Dopamine agonist pergolide C. Glucocorticoid prednisone D. Proton pump inhibitor omeprazole
A
A
19
Q
Which of the following is an indication for surgery in prolactinomas?
A. Desire for pregnancy
B. Large tumor with suprasellar extension
C. Pituitary apoplexy
D. Tumor with parasellar extension
A
C (This is a medical emergency as it can lead to necrosis of the pituitary gland)
20
Q
High prolactin levels can be seen in the following states EXCEPT A. Acromegaly B. Chest wall stimulation C. Hyperthyroidism D. Pregnancy
A
C (It should be HYPOthyroidism)
21
Q
Which of the following is true of the clinical manifestations of prolactinomas?
A. Galactorrhea is present in 50-80% of men with hyperprolactinemia
B. Lateral extension of the prolactinoma into the cavernous sinus can lead to visual deficits
C. Suprasellar extension of the prolactinoma can lead to ptosis
D. Women generally present earlier in the course of the disease and with smaller tumors
A
D (Lateral extension leads to ptosis, suprasellar extension leads to bitemporal hemianopsia)
22
Q
Your patient presenting with secondary amenorrhea who was diagnosed with prolactinoma already has normal menses but her prolactin level is still 40ug/L. This was repeated after another month and it is still 45 ug/L. She is currently on bromocriptine 2.5 mg 1 tablet once a day for the last 6 months and the dose is well tolerated. The next step should be A. Do an MRI B. Increase the dose C. Send the patient for surgery D. Stay on the same dose
A
B
23
Q
An invasive pituitary tumor eroded into the sellar floor. The following is the expected clinical manifestation of this mass effect
A. Bitemporal hemianopsia
B. Cavernous sinus thrombosis
C. CSF leak
D. Opthalmoplegia or extraocular muscle paralysis
A
C (A is if with superior invasion, B and D with lateral invasion.)
24
Q
Microadenomas are
A.
A
C
25
```
Best screening test for acromegaly
A. IGF-1
B. Growth hormone levels
C. Growth hormone suppression test
D. GHRH levels
```
A
26
```
Acromegalic patients are at increased risk for malignancy hence this screening test is recommended
A. Colonoscopy
B. PET scan
C. Bone scan
D. MRI
```
A
27
Transphenoidal surgery is the treatment of choice for the following tumors EXCEPT
A. GH-secreting tumors (sommatotroph adenomas)
B. Non-functioning macro-adenomas with mass effects
C. Prolactin-secreting adenomas
D. TSH-secreting pituitary adenomas
C
28
```
Acromegaly is diagnosed when the GH level following a 75-gm glucose level is
A. 1.0 mg/ml
B. Above 2 ng/ml
C. Below 2 ng/ml
D. 2 ng/ml
```
B
29
```
The following clinical manifestations can be found in patients with GH excess EXCEPT
A. Cardiac enlargement
B. Diabetes insipidus
C. Goiter
D. Hyperglycemia
```
B
30
The following are true of GH-secreting tumors EXCEPT
A. Clinical manifestations include diabetes mellitus, hypertension, and obstructive sleep apnea
B. GH-secreting tumors lead to enlargement of external features but not internal organs
C. It leads to gigantism of GH hypersecretion starts before epiphyseal growth plate closure
D. There is indolent development of signs and symptoms
B – both internal organs and external features are affected
31
```
The treatment of choice for a well-defined pituitary somatotroph macroadenoma
A. High-dose cabergoline
B. Once-weekly lantreotide
C. Radiotherapy
D. Surgical excision
```
D
32
Which of the following statements is FALSE?
A. GH mainly acts via IGF-1
B. GH is the most abundant anterior pituitary hormone
C. GH secretion is enhanced by somatostatin
D. Somatotrope cells constitute up to 50% of total anterior pituitary cell population
C – GH secretion is inhibited by somatostatin
33
Which is true regarding non-functioning pituitary adenomas?
A. Even asymptomatic small non-functioning pituitary adenomas warrant surgery
B. Non-functioning pituitary tumors have very good response to dopamine agonists
C. They are the most common type of pituitary adenoma
D. They are usually microadenomas at the time of diagnosis
C
34
Which of the following states is TRUE regarding the use of bromocriptine?
A. Achievement of normal fertility is not a realistic endpoint of treatment with bromocriptine
B. Bromocriptine should be started at the maximum effective therapeutic dose right away to achieve the treatment targets
C. Bromocriptine should be taken with food to minimize adverse effects
D. Diarrhea is the most common gastrointestinal side effect with use of bromocriptine
C
35
Which of the following is the mechanism of action of octreotide for the treatment of GH-secreting tumors?
A. Competes for the IGF-1 receptor
B. Competitive inhibition for the GH receptor
C. Dopaminergic agonist inhibiting GH secretion
D. Somatostatin-like effect inhibiting the release of GH
D
36
The following conditions will be amenable to growth hormone injections EXCEPT
A. Dwarfism due to congenital hypothyroidism
B. Growth hormone deficiency in an 11 year old child developing after surgery of craniopharyngoma in the sellar area
C. Growth restriction of a 13 year old due to chronic kidney disease
D. Short stature due to Turner’s syndrome
A
37
```
The following drugs can potentially decrease the cortisol levels in Cushing’s syndrome EXCEPT
A. Aminogluthetimide
B. Ketoconazole
C. Metyrapone
D. Octreotide
```
D
38
```
The following drug is a dopamine agonist
A. Cabergoline
B. Octreotide
C. Pegvisomant
D. Somatropin
```
A
39
```
In replacing hormones in an adult patient with acute presentation of panhypopituitarism, the following is the first drug which should be given in order of priority
A. Growth hormone
B. Intravenous dexamethasone
C. Intravenous hydrocortisone
D. Levothyroxine or thyroid hormone
```
C
40
Congenital adrenal hyperplasia is brought about by
A. Autosomal recessive enzymatic defect
B. Autosomal dominant enzymatic defect
C. Enzymatic defect with familial clustering
D. Sporadic genetic mutation
A
41
```
Which of the following is a possible presentation of congenital adrenal hyperplasia?
A. Female hermaphroditism
B. Gigantism
C. Hypogonadism
D. Virilization
```
D
42
```
The symptomatology of Addison disease can be attributed to
A. Hypogonadism
B. Pan-hypoadrenalism
C. Pan-hypopituitarism
D. Selective aldosterone deficiency
```
B
43
```
Which of the following is the characteristic pathologic picture of Addison disease?
A. Acute suppurative adrenalitis
B. Adrenal infarct and hemorrhage
C. Lymphocytic adrenalitis
D. Minimal change disease
```
C
44
Which of the following is a cause of acute adrenal insufficiency (adrenal crisis)?
A. Abrupt withdrawal of diuretic therapy
B. Acute stress in a patient with congenital adrenal hyperplasia
C. Bilateral adrenal hemorrhagic infarction
D. Chronic overdosage of steroid therapy
C
45
```
Which of the following can lead to secondary adrenal insufficiency?
A. Adrenal space-occupying lesions
B. Basal ganglia lacunar infarcts
C. Hypothalamic hemorrhagic infarct
D. Pontine infarct
```
C
46
```
Conn syndrome refers to
A. Adrenogenital syndromes
B. Hyperaldosteronism
C. Hypercortisolism
D. Syndrome of renin-angiotensin-aldosterone inappropriate activation
```
B
47
```
Primary hyperadrenalism in the pediatric age group should raise the clinical consideration of
A. ACTH-secreting pituitary adenoma
B. An adrenal carcinoma
C. An adrenal pheochromocytoma
D. An adrenocortical adenoma
```
B
48
```
S100 immunohistochemistry in pheochromocytomas reacts with what cell?
A. Endothelial cell
B. Myoepithelial cell
C. Retinaculum cell
D. Sustentacular cell
```
D
49
```
Condition associated with secondary hyperaldosteronism
A. Cerebral infarct
B. Chronic hypertension
C. Pregnancy
D. Pulmonary endocrine tumors
```
C
50
```
The typical pathologic architecture of a pheochromocytoma is referred to as
A. Meisterstucke
B. Quegl’occhi
C. Waserhelle
D. Zellballen
```
D
51
Which of the following statements is/are true
A. A BP of 160/90 in a 45 year old suggests secondary hypertension
B. Oral contraceptives, tubal ligation, and vasectomy can cause secondary hypertension
C. Sleep apnea may cause hypertension
D. The most common cause of hypertension is renal disease
C
52
```
When screening for endocrine hypertension, which antihypertensive interferes least with diagnostic testing?
A. Angiotensin receptor blockers
B. Beta blockers
C. Calcium channel blockers
D. Diuretics
```
C
53
Which of the following statements are true of aldosteronism?
A. Aldosteronomas are usually benign
B. Hypokalemia is found in all patients with primary aldosteronism
C. Patients present with edema
D. Symptoms are due to low phosphate levels
A (D is false because it should be low potassium levels)
54
The following are differentials in a patient with hypertension and hypokalemia EXCEPT
A. Adrenal insufficiency
B. Cushing’s syndrome
C. Essential hypertension with diuretic use
D. Hyeraldosteronism
A
55
The following is/are true regarding the diagnosis of primary hyperaldosteronism
A. Abdominal CT scan may be done right away after a positive screening test
B. Confirmatory testing is done using a saline loading test to document failure of suppression of aldosterone after a phase of limited salt intake
C. Screening test is made by computing for the serum aldosterone (ng/dL)
D. The picture is often systolic hypertension without edema
C
56
```
The treatment of choice in patients with idiopathic hyperaldosteronism is
A. Chelation
B. Medical
C. Surgery
D. Radiation
```
B
57
True about pheochromocytomas
A. These are adrenal cortical tumors of chromaffin cells derived from the neural crest
B. Are extra-adrenal in location in 10% of cases and are termed paragangliomas
C. Malignant pheochromocytomas can be distinguished from benign ones by immunostaining the adrenal mass
D. May be familial in 5% of the cases
B (Note on D, it should be 10%)
58
The following are true in the diagnosis of pheochromocytoma tests EXCEPT
A. Plasma metanephrines are the most sensitive and least susceptible to false positives
B. Urinary VMA and total metanephrines are commonly used for initial testing
C. A value slightly above normal confirms the diagnosis
D. Imaging using MIBG and PET is done in selected cases
C
59
```
In patients with extra-adrenal pheochromocytomas, the procedure that may localize it best is
A. MRI
B. MIBG
C. CT scan
D. PET scan
```
B
60
```
The treatment of choice for pheochromocytoma is
A. Surgery
B. Radiation
C. Chemotherapy
D. All are equally effective
```
A
61
Which of the following tests would differentiate between an ACTH-secreting pituitary tumor and ectopic ACTH secretion?
A. 1 mg overnight dexamethasone suppression test
B. 24-h urinary free cortisol
C. Bilateral inferior petrosal sinus sampling
D. Midnight salivary cortisol
C
62
```
ACTH levels are expected to be low in patients with Cushing’s syndrome due to
A. Cushing’s disease
B. Dexamethasone intake
C. Bronchial carcinoid
D. Medullary thyroid carcinoma
```
B
63
```
Patients with cortisol-producing adrenal adenomas are expected to have
A. Low CRH, low ACTH, high cortisol
B. High CRH, low ACTH, low cortisol
C. Low CRH, high ACTH, high cortisol
D. High CRH, high ACTH, low cortisol
```
A
64
All of the following are used as a screening test for Cushing’s syndrome EXCEPT
A. 8 AM serum cortisol
B. 1 mg overnight dexamethasone suppression test
C. 24h urine free cortisol
D. Midnight salivary cortisol
A
65
```
The most common cause of endogenous Cushing’s syndrome is
A. Cortisol-secreting adrenal adenoma
B. ACTH-secreting pituitary adenoma
C. Ectopic CRH-secreting tumor
D. Ectopic ACTH-secreting tumor
```
B
66
A patient consulted for weight gain, acne, diabetes, and hypertension. You noted that she was obese, had moon facies, violaceous abdominal striae, and thin skin. Her 8 AM serum cortisol is elevated at 200 nmol/L even if she took 1 mg dexamethasone the previous midnight. Her ACTH level is undetectable. The next step in the diagnostic evaluation is
A. Do high dose dexamethasone suppression test
B. Do a CT scan of the adrenals
C. Do bilateral inferior petrosal sinus sampling
D. Administer CRH and measure plasma ACTH afterwards
B
67
Which of the following screening tests for Cushing’s syndrome is done to get the cumulative secretion of cortisol over a specified period of time to obviate the diurnal variation in cortisol secretion?
A. 1 mg dexamethasone suppression test
B. 24h urine free cortisol
C. Midnight salivary cortisol
D. High dose dexamethasone suppression test
B
68
Which of the following screening tests for Cushing’s syndrome is based on failure of endogenous cortisol secretion to decrease in response to the administration of exogenous glucocorticoid?
A. 1 mg overnight dexamethasone suppression test
B. Captopril challenge test
C. Clonidine suppression test
D. Cosyntropin or ACTH stimulation test
A
69
```
The treatment of choice for a patient with Cushing’s disease is
A. Bilateral adrenalectomy
B. Transsphenoidal excision
C. Radiation therapy
D. Ketoconazole
```
B
70
```
Most common cause of Cushing’s syndrome
A. Exogenous glucocorticoid intake
B. ACTH-secreting pituitary tumor
C. Cortisol-secreting adrenal adenoma
D. Ectopic CRH-secreting tumor
```
A
71
```
A newborn’s genitalia shows well-developed pigmented empty scrotum with rugae, phallic length of 2.8 cm with adequate circumference and single opening at the tip. What sex should you indicate in the birth certificate of this newborn?
A. Male
B. Female
C. Mosaic
D. Defer sex assignment
```
D
72
```
The most common cause of ambiguous genitalia in a newborn is
A. Mixed gonadal dysgenesis
B. Congenital adrenal hyperplasia
C. Severe hypospadia
D. Low estrogen to testosterone ratio
```
B
73
```
In a 46 XY fetus, what directs the bipotential gonads to develop into testes?
A. Testosterone determining factor
B. Mullerian inhibiting substance
C. SRY transcription factor
D. Dihydrotestosterone
```
C
74
```
In a 46 XX fetus, the bipotential gonads become
A. Ovaries
B. Uterus, fallopian tubes, upper vagina
C. Wolffian ducts
D. A and B only
```
A
75
The most common enzyme deficiency causing congenital adrenal hyperplasia is absence of 21-hydroxylase. Which profile below confirms the diagnosis?
A. Elevated blood testosterone and low estradiol
B. Elevated 17-hydroxyprogesterone and low cortisol
C. Low plasma cortisol and elevated potassium
D. Hypoglycemia and hyponatremia
B
76
Which combination of manifestations best describes untreated late onset congenital adrenal hyperplasia
A. 8 year old female, tall for age, chubby, bushy eyebrows, tanner 3 breast, fine pubic hair
B. 13 year old female, tall, no menses, tanner 1 breast, broad shoulders, tanner 4 pubic hair extends to navel, deep voice
C. Tall 7 year old male with body odor, normal sized penis and testes
D. Short 5 year old male with hairy arms and legs, globular abdomen with striae, flushed cheeks, buffalo hump
B
77
A female newborn tests positive for congenital adrenal hyperplasia. The confirmatory test is positive. What is the treatment of choice for classic simple virilizing congenital adrenal hyperplasia in a genetic female?
A. Observe for progression of symptoms and repeat hormone profile after 1 month
B. Fludrocortisone
C. Hydrocortisone
D. Aromatase inhibitor
C
78
If untreated, classic congenital adrenal hyperplasia may result in
A. Male with enlarged penis and pubic hair at the age of 5 years old
B. Female with menarche occurring before the age of 8 years old
C. 13/F with palpable masses in labia majora and clitoromegaly
D. 14/M with tanner 3 pubic hair, testes 12 ml and deepening voice
A
79
Baby Tim is 10 days old. His newborn screening is positive for congenital adrenal hyperplasia. He was recalled for evaluation. On PE, you note prominent dark areola, hyperpigmentation of armpits, inguinal areas, and scrotum. Both testes are descended. The penis is 4 cm. What is the best medical plan for Tim?
A. Reassure mother that Tim is fine. She should however bring him back if he refuses to feed or begins to vomit
B. Do karyotyping
C. Do ultrasound of abdomen and pelvic area
D. Extract blood for confirmatory test
D
80
The following are TRUE of capillary blood glucose EXCEPT
A. The result is 10-15% lower than plasma glucose
B. It is used mainly in point-of-care testing
C. It can be used for specimens other than blood
D. It can be used as an alternative to random plasma glucose testing
C
81
```
Blood for oral glucose tolerance test is collected using ______-top tube with _____ anticoagulant
A. gray: EDTA
B. purple: EDTA
C. gray: fluoride
D. red: no
```
C
82
```
Autoantibody against DM type I which is more commonly seen in adults
A. Islet cell Ag 512 autoAb
B. Ab to GAD65
C. Insulin autoAb
D. Insulinoma-associated Ag-2
```
B
83
```
Which of the following methods of glucose determination is the most specific?
A. Somogyi-Nelson method
B. Ferricyanide
C. Glucose oxidase
D. Hexokinase
```
D
84
TRUE of sodium nitroprusside
A. Used as a quantitative test to detect levels of ketone bodies
B. Used exclusively for whole blood
C. Detects the ratio of betahydroxybutyric acid to acetoacetic acid
D. The more ketones the patient has, the deeper purple it gets
D
85
Glycosylated hemoglobin is a measure of glycemic control over the past 3 months. This time frame is dependent on
A. Life span of the RBC
B. Labile bonding fraction of glucose
C. Time it takes for glucose to irreversibly bind to hemoglobin
D. AOTA
A
86
```
Fasting plasma glucose is ideally taken every _____ to monitor a person’s glucose levels
A. 3 months
B. 6 months
C. 2 years
D. 3 years
```
NA
87
According to the National Cholesterol Education Program Adult Treatment Panel III, which of the following parameters is included in the diagnosis of metabolic syndrome?
A. Glucose of >110 mg/dl
B. HDL of = 130 mg/dl
D. Waist circumference of >= 78 cm for women
A
88
Components of metabolic syndrome based on the International Diabetes Federation criteria include the following EXCEPT
A. Central obesity as measured by waist circumference of >= 90 cm (males), >= 80 cm (females)
B. BP >=140/90 or on treatment for hypertension
C. Fasting blood glucose >=100 mg/dl including type 2 diabetes
D. Dyslipidemia defined as hypertriglyceridemia (>=150 mg/dl) or low HDL (
B – should be 130/85
89
```
The metabolic syndrome is a constellation of metabolic abnormalities that confers an increased risk for cardiovascular diseases and
A. Obesity
B. Diabetes
C. Cancer
D. Depression
```
B
90
True of obesity in relation to metabolic syndrome
A. Central obesity is shown to have great association with cardiovascular risk compared with generalized obesity
B. Subcutaneous adipose tissue secrete inflammatory markers which ultimately promote insulin resistance and atherosclerosis
C. The best anthropometric measure of visceral fat is the waist-hip ratio
D. Central or android obesity is manifested by pear-shaped distribution of body fat
A
91
```
The most accepted and unifying hypothesis to describe the pathophysiology of metabolic syndrome
A. Hyperglycemia
B. Stress
C. Insulin resistance
D. Atherosclerosis
```
C
92
Which of the following statements is true regarding insulin resistance?
A. An expanded adipose tissue mass in obese patients results in abundant free fatty acids released into the circulation which lead to decreased insulin sensitivity
B. The pancreatic reaction to increased insulin resistance is augmentation of glucagon release
C. Cytokines released from adipose tissues prevents thrombosis
D. Abundant VLDL production in the liver results in decreased serum HDL and LDL levels
NA
93
```
According to the Asia-Pacific cut-offs for overweight and obesity, a BMI of 26 is
A. Normal
B. Overweight
C. Obese I
D. Obese II
```
C
94
For patients with metabolic syndrome and diabetes, the LDL cholesterol should be reduced to
A.
D
95
```
Which of the following is considered a macrovascular complication of DM?
A. Diabetic retinopathy
B. End stage renal disease
C. Diabetic gastroenteropathy
D. Peripheral vascular disease
```
D
96
```
A 45/M consulted for abnormal laboratory tests. He is asymptomatic and with no known illnesses. Initial FBS was at 125 mg/dl. A 75 gm OGTT was done which showed FBS of 115 mg/dl and 2 hour blood sugar of 134 mg/dl. What is his diagnosis?
A. Impaired fasting glucose
B. Impaired glucose tolerance
C. Type 2 diabetes
D. Normal glucose tolerance
```
A
97
MODY type 2 is characterized by genetic defects of beta cell function with mutation in
A. Insulin-promoter factor-1
B. Glucokinase
C. Hepatocyte nuclear transcription factor 1alpha
D. Hepatocyte nuclear transcription factor 4alpha
B
98
Patient came in with the following laboratory results: FBS 137 mg/dl, 2 hours 75g OGTT 224 mg/dl. The tests were done on 2 separate days. Based on WHO criteria, what is your diagnosis?
A. Normoglycemic
B. Impaired fasting glucose
C. Impaired fasting glucose and impaired glucose tolerance
D. Diabetes mellitus
D
99
Patient came in with the following laboratory results: FBS 101 mg/dl, 2 hours 75g OGTT 187 mg/dl. The tests were done on 2 separate days. Based on WHO criteria, what is your diagnosis?
A. Normoglycemic
B. Impaired fasting glucose
C. Impaired fasting glucose and impaired glucose tolerance
D. Diabetes mellitus
C
100
Who among the following asymptomatic patients would need an earlier screening for DM?
A. 36 year old male, BMI of 25, with a second degree relative with DM
B. 39 year old female, BMI of 25, with a triglyceride level of 189 mg/dl
C. 38 year old female, BMI of 25, Caucasian, who previously delivered a baby weighing 7.9 lbs
D. 37 year old male, BMI of 25, with HDL cholesterol of 50 mg/dl
B
101
Which of the following statement is TRUE about the clinical manifestations of patients with Type 1 diabetes mellitus?
A. Usually insidious in nature
B. Peak age of presentation at 40 years of age
NA
102
```
Which of the following blood glucose examination results is highly suggestive of diabetes mellitus in an asymptomatic individual?
A. Fasting blood sugar = 114 mg/dl
B. 2 hour 75g OGTT = 183 mg/dl
C. Random blood sugar = 259 mg/dl
D. HbA1c = 6.3%
```
C
103
An 11 year old boy consulted in a pediatric clinic for endocrine evaluation. He had polyphagia but no polyuria. His body mass index was 25. His fasting blood glucose level was 111 mg/dl. Your assessment is
A. Overweight, impaired glucose tolerance
B. Obesity, impaired fasting blood glucose
C. Overweight, diabetes mellitus
D. Obesity, diabetes mellitus
B
104
In DKA, hypoinsulinemia results in
A. Hyperglycemia, hypernatremia and hyperkalemia
B. Hyperglycemia, hypernatremia and hypokalemia
C. Hyperglycemia, osmotic diuresis, ketonemia and ketonuria
D. Hyperglycemia, hypotriglyceridemia, metabolic acidosis
C
105
```
A 3 day old full term baby girl was referred by persistent hyperglycemia. She was born to a health 28 year old mother with no history of diabetes mellitus. She denies use of medications except for vitamins during pregnancy. She is diagnosed to have neonatal diabetes, likely mutation of KCNJ11 gene encoding Kir 6.2. The channel affected by such mutation is the
A. Calcium channel
B. Sodium channel
C. Glucose channel
D. Potassium channel
```
D
106
The following medications can cause hyperglycemia
A. L-asparaginase, tacrolimus, and glucocorticoid
B. Glucocorticoid, cyclosporine, and thiazolidinedione
C. Alpha-glucosidase inhibitor, L-asparaginase, and cyclosporine
D. Thiazolidinedione, biguanide, and alpha-glucosidase inhibitor
A
107
A 10 year old girl was diagnosed to have diabetes mellitus and has been maintained on insulin therapy. Her daily insulin requirement was 0.2U/kg/day. Her latest HbA1c was 6.2%. She has gained weight after start of insulin therapy; her current BMI was 24. A recent determination of C-peptide showed elevated level. She most likely has
A. Maturity onset diabetes of the young (MODY)
B. Type 2 diabetes mellitus
C. Type 1 diabetes mellitus
D. Transient stress hyperglycemia
B
108
The HbA1c goal for type 1 diabetes mellitus in pediatric age group is
A. 8.5% in toddlers and pre-schoolers (0 to less than 6 years of age)
B. 8% in school age (>6-12 years of age)
C. 7.6-8% in adolescents (13-19 years of age)
D. 7.5% or less in all pediatric age groups
D
109
The 3 useful signs for assessing dehydration and predicting acidosis in young children are
A. Capillary refill time is >2.5 seconds, inelastic skin, and hyperpnea
B. Capillary refill time is 3 seconds, bradycardia, and rising BP
A
110
Which of the following are signs and symptoms of hypoglycemia
A. Tremor, mood changes, dry skin
B. Weakness, cold sweat, tremor
C. Pallor, abdominal pain, limited joint mobility
D. Dizziness, vomiting, and hyperventilation
B
111
In which of the following categories should women undergo routine screening for gestational diabetes?
A. Age greater than 25 years
B. BMI greater than 30
C. Family history of DM in a first-degree relative
D. Southeast Asian
E. AOTA
E
112
When should screening for gestational DM be done among Filipinas?
A. Wait until the 24th to 28th week of gestation
B. 1st prenatal check up
C. Only when the patient has at least one risk factor for developing diabetes
D. Preconception
E. 2nd or 3rd trimesters
B
113
Which are the diagnostic criteria for gestational diabetes mellitus followed by IADSPG and our local guidelines?
A. Elevated 50g glucose challenge test then 155 mg/dl on the 2nd hour after a 100 g oral glucose tolerance test (OGTT)
B. Fasting glucose of 95 mg/dl, and after a 75g OGTT 1h – 191 mg/dl, 2h – 160 mg/dl
C. Fasting glucose of 105 mg/dl, and after a 100g OGTT 1h – 190 mg/dl, 2h – 165 mg/dl
D. Fasting glucose of 92 mg/dl, and after a 75g OGTT 1h – 180 mg/dl, 2h – 153 mg/dl
E. Fasting glucose of 95 mg/dl, and after a 100g OGTT 1h – 180 mg/dl, 2h – 155 mg/dl
D
114
```
Which of the following is/are the placental hormone(s) NOT involved in aggravating insulin resistance during pregnancy?
A. Growth hormone
B. Placental lactogen
C. Corticotropin-releasing hormone
D. Human chorionic gonadotropin
```
D
115
Based on a systematic review and meta-analysis, which of the following needs more trials to strengthen the rationale in treating gestational diabetes mellitus?
A. Prevention of pre-eclampsia
B. Birth weight of >4000 g
C. Admittance to the Neonatal Intensive Care Unit
D. Shoulder dystocia
C
116
What does the Pedersen Hypothesis say?
A. High concentrations of maternal glucose give rise to increased nutrient transfer to the fetus and increase fetal growth
B. Fetal hyperglycemia leads to beta cell hypertrophy
C. Poorly controlled gestational diabetes mellitus shortens gestation and increases the risk for Caesarean section
D. Fetal hyperglycemia during the 2nd and 3rd trimesters can cause chronic hypoxemia and delay in the development of the nervous system
A
117
What are the glycemic targets for gestational diabetes mellitus?
A. Preprandial
C
118
```
Which of the following insulins is/are not approved for the treatment of gestational diabetes mellitus?
A. Insulin glulisine
B. Neutral protamine Hagedorn
C. Regular insulin
D. Insulin lispro
```
A
119
```
This apo-protein contained in LDL, VLDL, IDL, and Lp (a) is the ligand of LDL receptors in the liver and the peripheral tissues
A. B-100
B. B-48
C. A-I
D. E
```
A
120
```
Lipoprotein associated with atherosclerosis and localized in atherosclerotic plaques with a unique apoprotein structurally similar to plasminogen; it inhibits plasminogen activation, and promotes thrombosis
A. HDL
B. IDL
C. Lp (a)
D. VLDL
```
C
121
Statins can decrease LDL levels by which of the following mechanism?
A. Stimulation of HMG-CoA reductase
B. Decrease in synthesis of triglycerides
C. Upregulation of LDL receptors in the hepatocyte
D. Increase in fatty acid oxidation
C
122
```
A patient taking amiodarone and macrolide antibiotic but will highly benefit from a statin should be prescribed
A. Atorvastatin
B. Pravastatin
C. Simvastatin
D. Rosuvastatin
```
B
123
Which of the following is TRUE about statin toxicity
A. Hepatotoxicity may manifest as a precipitous fall in LDL
B. Elevation of liver enzymes is an indication to stop therapy even in the absence of symptoms
C. Generalized skeletal muscle pain, tenderness, or weakness are common side-effects which do not necessitate further examination
A
124
```
Which of the following transcriptionally up-regulates lipoprotein lipase, apoA-I and apoA-II, downregulates apoCIII, and is a drug of choice for lowering triglycerides
A. Colestipol
B. Ezetimibe
C. Fenofibrate
D. Simvastatin
```
B
125
```
A patient with high LDL and low HDL was given niacin to decrease cardiovascular risk. The side-effects/toxicities of this drug include which of the following
A. Cutaneous vasoconstriction
B. Hypoglycemia
C. Hyperuricemia
D. Renal failure
```
C
126
```
A female taking a drug to decrease LDL cholesterol developed night blindness, easy bruisability, and heavy menstrual bleeding suspected to be due to vitamin deficiency. The patient is most likely taking what drug for dyslipidemia
A. Atorvastatin
B. Colestipol
C. Gemfibrozil
D. Niacin
```
B
127
```
A patient with jaundice was admitted for fever with ALT 5x the normal. A random blood sugar test showed a value of 278 mg/dl. On repeat before breakfast, it was still 259 mg/dl. The ideal drug to use is
A. Metformin
B. Insulin
C. Linagliptin
D. Acarbose
```
B
128
```
The following types of insulin can specifically address prandial or meal-related elevation of blood sugar
A. NPH insulin
B. Insulin glargine
C. Insulin aspart
D. Insulin detemir
```
C
129
```
Drug of choice for a 12 year old overweight type 2 diabetic
A. Insulin
B. Acarbose
C. Metformin
D. Sulfonylurea
```
C
130
```
Drug which causes glucose independent insulin secretion
A. Acarbose
B. Piglitazone
C. Glimepiride
D. Sitagliptin
```
C
131
```
Weight gain is an expected side effect or adverse drug reaction of this drug
A. Saxagliptin
B. Voglibose
C. Glipizide
D. Metformin
```
C
132
The following are expected side effects of the drug sitagliptin
A. Decreased glucagon secretion from the alpha cells of the pancreas
B. Decreased bioavailability and blood levels of endogenous GLP-1
C. Increased hepatic glucose production
D. Increased insulin secretion from the beta cells during fasting
A
133
```
During the “Habagat” flooding the supplies of insulin syringes could not be delivered to the district hospital so all that was available were tuberculin syringes. If 36 units of insulin is to be injected, how many ml of this liquid should be aspirated into the syringe?
A. 0.036 ml
B. 0.36 ml
C. 3.6 ml
D. 36 ml
```
B
134
```
You have a patient who is taking a combination of anti-diabetic agents to try to control his blood sugar. One of his tablets is taken 3x a day just before meals. Which drug is this most likely to be?
A. Metformin
B. Repaglinide
C. Acarbose
D. Pioglitazone
```
B or C
135
A patient was injected with insulin last night at around 8 pm just before he had dinner. He woke up at 3 am with cold sweats, confusion, and tremulousness. You confirm hypoglycemia through capillary testing. This is most probably the type of insulin that was injected
A. Insulin glargine
B. Regular human insulin
C. NPH or neutral protamine Hagedorn insulin
D. Insulin aspart
C (B and D have short effects, A has no peaks)
136
```
This type of insulin cannot be mixed with other insulins or with IV fluid due to acidic pH
A. Insulin glulisine
B. Insulin glargine
C. Insulin lispro
D. Regular insulin
```
B
137
```
You are the clerk admitted a patient to the Internal Medicine wards due to decompensated congestive heart failure. The patient is previously on regular OPD follow up and already has a set of medications that he has brought. The resident asks you to audit his medications list and continue only those that are safe. Which of the following anti-diabetic medications will you retain?
A. Pioglitazone
B. Metformin
C. Glibenclamide
D. Insulin glargine
```
D
138
```
You have a diabetic patient who is using various anti-diabetic agents. Recently her renal function deteriorated so that her estimated GFR is only 30% and she is beginning to have edema or swelling of her feet. Which of the following drugs can you still safely maintain and not discontinue?
A. Metformin
B. Glimepiride
C. Pioglitazone
D. Sitagliptin
```
D
139
The same patient above was subsequently shifted to insulin. Her renal function continued to deteriorate over several months. What do you anticipate will happen to her dose of insulin if renal function continues to worsen?
A. Her dose will increase since insulin requirements will increase with worsening GRF
B. Excretion or clearance of insulin will be decreased and hence, insulin requirements will diminish
C. It will be unchanged
D. It will either increase or decrease (not predictable)
B
140
```
Drug of choice for an elderly 70 year old diabetic due to low risk of hypoglycemia and no risk for systemic adverse effects
A. Glipizide
B. Pioglitazone
C. Acarbose
D. Insulin
```
C
141
```
Based on efficacy criteria, which among the following drugs is considered the most effective in lowering HbA1c?
A. Megletinides/glinides
B. DPP4 inhibitors
C. Biguanides
D. Thiazolidinediones
```
C
142
```
Which of the following drugs has a glucose-dependent mechanism of action which suppresses glucagon and stimulates insulin production?
A. Megletinides/glinides
B. Biguanides
C. Incretins or Incretin-based therapy
D. Thiazolidinediones
```
C (GLP-1 agonist and DPP4)
143
```
Weight loss is an expected side effect of this drug
A. Dapagliflozin
B. Gliclazide
C. Pioglitazone
D. Insuline glargine
```
A
144
```
Which of the following drugs has a “do not prescribe” recommendation from some of the clinical practice guidelines due to excessive hypoglycemia?
A. Glipizide
B. Glibenclamide
C. Metformin
D. Repaglinide
```
B
145
```
A newly diagnosed 42 year old patient with an FBS of 130 and HbA1c of 7.3% during the first visit will likely receive the following treatment
A. Metformin
B. Acarbose
C. Diet and exercise
D. Pioglitazone
```
A and C
146
```
The following is an expected side effect of an SGLT-2 inhibitor when given among diabetic individuals
A. Diarrhea
B. Lactic acidosis
C. Weight gain
D. Genital fungal infections
```
D
147
The hyperosmolality in hyperosmolar hyperglycemia state (HHS)
A. Is largely an intracellular event, as free water moves from the vascular space into the cells
B. Is a result of osmotic diuresis, with loss of water, sodium, and potassium
C. Is due to the intracellular flux of potassium to compensate for metabolic acidosis
D. Is an effect of idiogenic osmoles that draw water from the extracellular space
E. Does not affect the central nervous system because of the blood-brain barrier
D
148
HHS is a condition characterized by
A. Severe metabolic alkalosis, azotemia, hypercarbia, and hyperphosphatemia
B. Weakness, confusion, and lethargy that is easily corrected by IV glucose administration
C. Dehydration, mental status deterioration, and relative hypokalemia
D. Intractable metabolic acidosis, hyperkalemia, and anemia
E. Pulmonary congestion, ascites, and bipedal edema
C
149
```
The most common clinical presentation of HHS
A. Kussmaul breathing
B. Seizure
C. Hemiparesis
D. Hypertension
E. Altered sensorium
```
E
150
Effective serum osmolality
A. Is calculated using corrected sodium level and plasma glucose
B. Is the plasma concentration of sodium, glucose, and urea nitrogen, which are osmotically active particles
C. Is calculated using measured sodium and plasma glucose
D. Is the difference of positively-charged and negatively-charged ions in the blood
E. Is the concentration of particles that have no effect on intracellular volume
BONUS
151
Successful treatment of HHS involves
A. Immediate correction of acidosis, and withholding insulin therapy until serum potassium is restored to normal level
B. Early subcutaneous or intramuscular insulin administration to correct hyperglycemia
C. Enteral fluid administration and immediate per orem feeding to alleviate dehydration
D. Intermittent IV insulin boluses and conservative sodium replacement, especially in the elderly
E. Correction of dehydration with appropriate fluid therapy and control of hyperglycemia with IV insulin
E
152
Diabetic ketoacidosis is best defined by
A. Insulin resistance with concomitant increased stress hormones
B. Acidosis, ketonemia and hypoglycemia
C. Metabolic acidosis, ketonemia, hyperglycemia, and hyperosmolarity
D. Decreased circulating insulin, decreased glucose production, and acidosis
C
153
The following are management goals in treatment of DKA EXCEPT
A. Reduction of acidosis by alkali therapy
B. Restoration of fluid balance
C. Correction of glucose imbalance
D. Ensure patient comfort and well-being
A
154
The most common cause underlying the occurrence of DKA in a known diabetic is
A. Uncontrolled fulminant infection
B. Omission of insulin
C. Hormonal imbalance in an adolescent
D. Liver failure from chronic use of insulin
B
